Insulin autoimmune syndrome: case report

CONTEXT: Insulin autoimmune syndrome (IAS, Hirata disease) is a rare cause of hypoglycemia in Western countries. It is characterized by hypoglycemic episodes, elevated insulin levels, and positive insulin antibodies. Our objective is to report a case of IAS identified in South America. CASE REPORT: A 56-year-old Caucasian male patient started presenting neuroglycopenic symptoms during hospitalization due to severe trauma. Biochemical evaluation confirmed hypoglycemia and abnormally high levels of insulin. Conventional imaging examinations were negative for pancreatic tumor. Insulin antibodies were above the normal range. Clinical remission of the episodes was not achieved with verapamil and steroids. Thus, a subtotal pancreatectomy was performed due to the lack of response to conservative treatment and because immunosuppressants were contraindicated due to bacteremia. Histopathological examination revealed diffuse hypertrophy of beta cells. The patient continues to have high insulin levels but is almost free of hypoglycemic episodes.

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Main Authors: Moreira,Rodrigo Oliveira, Lima,Giovanna Aparecida Balarini, Peixoto,Patrícia Carla Batista, Farias,Maria Lucia Fleiuss, Vaisman,Mario
Format: Digital revista
Language:English
Published: Associação Paulista de Medicina - APM 2004
Online Access:http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802004000400010
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spelling oai:scielo:S1516-318020040004000102004-11-09Insulin autoimmune syndrome: case reportMoreira,Rodrigo OliveiraLima,Giovanna Aparecida BalariniPeixoto,Patrícia Carla BatistaFarias,Maria Lucia FleiussVaisman,Mario Hypoglycemia Hyperinsulinism Insulin Pancreatectomy Insulin antibodies CONTEXT: Insulin autoimmune syndrome (IAS, Hirata disease) is a rare cause of hypoglycemia in Western countries. It is characterized by hypoglycemic episodes, elevated insulin levels, and positive insulin antibodies. Our objective is to report a case of IAS identified in South America. CASE REPORT: A 56-year-old Caucasian male patient started presenting neuroglycopenic symptoms during hospitalization due to severe trauma. Biochemical evaluation confirmed hypoglycemia and abnormally high levels of insulin. Conventional imaging examinations were negative for pancreatic tumor. Insulin antibodies were above the normal range. Clinical remission of the episodes was not achieved with verapamil and steroids. Thus, a subtotal pancreatectomy was performed due to the lack of response to conservative treatment and because immunosuppressants were contraindicated due to bacteremia. Histopathological examination revealed diffuse hypertrophy of beta cells. The patient continues to have high insulin levels but is almost free of hypoglycemic episodes.info:eu-repo/semantics/openAccessAssociação Paulista de Medicina - APMSao Paulo Medical Journal v.122 n.4 20042004-01-01info:eu-repo/semantics/reporttext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802004000400010en10.1590/S1516-31802004000400010
institution SCIELO
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country Brasil
countrycode BR
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databasecode rev-scielo-br
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region America del Sur
libraryname SciELO
language English
format Digital
author Moreira,Rodrigo Oliveira
Lima,Giovanna Aparecida Balarini
Peixoto,Patrícia Carla Batista
Farias,Maria Lucia Fleiuss
Vaisman,Mario
spellingShingle Moreira,Rodrigo Oliveira
Lima,Giovanna Aparecida Balarini
Peixoto,Patrícia Carla Batista
Farias,Maria Lucia Fleiuss
Vaisman,Mario
Insulin autoimmune syndrome: case report
author_facet Moreira,Rodrigo Oliveira
Lima,Giovanna Aparecida Balarini
Peixoto,Patrícia Carla Batista
Farias,Maria Lucia Fleiuss
Vaisman,Mario
author_sort Moreira,Rodrigo Oliveira
title Insulin autoimmune syndrome: case report
title_short Insulin autoimmune syndrome: case report
title_full Insulin autoimmune syndrome: case report
title_fullStr Insulin autoimmune syndrome: case report
title_full_unstemmed Insulin autoimmune syndrome: case report
title_sort insulin autoimmune syndrome: case report
description CONTEXT: Insulin autoimmune syndrome (IAS, Hirata disease) is a rare cause of hypoglycemia in Western countries. It is characterized by hypoglycemic episodes, elevated insulin levels, and positive insulin antibodies. Our objective is to report a case of IAS identified in South America. CASE REPORT: A 56-year-old Caucasian male patient started presenting neuroglycopenic symptoms during hospitalization due to severe trauma. Biochemical evaluation confirmed hypoglycemia and abnormally high levels of insulin. Conventional imaging examinations were negative for pancreatic tumor. Insulin antibodies were above the normal range. Clinical remission of the episodes was not achieved with verapamil and steroids. Thus, a subtotal pancreatectomy was performed due to the lack of response to conservative treatment and because immunosuppressants were contraindicated due to bacteremia. Histopathological examination revealed diffuse hypertrophy of beta cells. The patient continues to have high insulin levels but is almost free of hypoglycemic episodes.
publisher Associação Paulista de Medicina - APM
publishDate 2004
url http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802004000400010
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AT peixotopatriciacarlabatista insulinautoimmunesyndromecasereport
AT fariasmarialuciafleiuss insulinautoimmunesyndromecasereport
AT vaismanmario insulinautoimmunesyndromecasereport
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